<h1>Request Group Rate</h1>

<form class="form-horizontal" role="form">
	<input type="hidden" name="referrer">
	<div class="form-group">
		<label for="fieldName" class="col-sm-2 control-label">Name</label>
		<div class="col-sm-4">
			<input type="text" id="fieldName" name="name">
		</div>
	</div>
	<div class="form-group">
		<label for="fieldGroupSize" class="col-sm-2 control-label">Group size</label>
		<div class="col-sm-4">
			<input type="number" id="fieldGroupSize" name="groupSize"><br>
		</div>
	</div>
	<div class="form-group">
		<label for="fieldEmail" class="col-sm-2 control-label">Email</label>
		<div class="col-sm-4">
			<input type="email" id="fieldEmail" name="email"><br>
		</div>
	</div>
	<div class="form-group">
		<div class="col-sm-offset-2 col-sm-4">
			<button type="submit" class="btn btn-primary">Submit</button>
		</div>
	</div>
</form>

{{#section 'jquery'}}
<script>
	$(document).ready(function(){
		$('input[name="referrer"]').val(document.referrer);
	});
</script>
{{/section}}
